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NHMRC Statement on Thermal Imaging for Early Breast Cancer Detection submission

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Please provide comment on Section 1 - NHMRC Statement Thermal Imaging for Early Breast Cancer Detection: 

Submission to the Australian National Health Medical Research Council on
Computerised Infra-Red Thermal Imaging as an adjunctive Breast Screen Tool

Submission by: Pauline Rose, (NHMRC has removed content for privacy reasons)

It is my understanding that the NHMRC does not support thermography, believing there is “no
evidence to demonstrate it is effective”. I hereby wish to offer a contrary opinion based on research
and clinical experience.

For over 40 years I have worked in health care, with a large part of that in Surgery and Women’s
Health. 12 years ago I was asked to speak to a large group of women who were aged between 35-75
years, during Breast October Month. At the end of this presentation I asked for a show of hands
regarding who had regular breast screening - one woman put up her hand!

The reasons they gave for not having screening were many and varied. During later discussions with
the National Breast Cancer Foundation I learned that only 40% of women entitled to free screening
make use of this service. I was deeply concerned with this information and after further surveys, I
trained as a thermographer and added this service to my clinic. Thermography is used for various
reasons, however my comments will be restricted to breast thermography.

An Introduction to Thermography:
Thermography is a test of physiology designed as an adjunctive test. It measures changes in far
infrared heat and does not replace other forms of anatomical screening. This is clearly stated in all
reports sent to our clients. Many women in the 50-69 year age group choose to have both
thermography and mammograms. The women who refuse to have mammograms under any
circumstances would previously not have been screened at all. In the event the reporting thermologist
detects an abnormal result the client is referred for full clinical assessment. All our reports are read by
qualified Thermologists (1). The importance of this is backed by Ng et al 2008. This research states:

1. Modern thermography is a useful adjunctive tool if the screening is done on time within the
recommended period
2. It is important that correct interpretation is done by qualified staff
3. Thermography shows great promise for further development

Numerous papers have been written in support of thermography and the development of modern
Digital Imaging equipment has increased the value of this technique.

Kennedy, Lee, Seeley 2009 (2):
“No single tool provides excellent predictability; however a combination that incorporates
thermography may boost both sensitivity and specificity. Ng and Kee 2008 (3) go on to say “highly
accurate diagnosis using thermography techniques can be achieved”. This technique has an accuracy
rate of 80.95% with 100% sensitivity and 70.6% specificity in identifying breast cancer. The results
are promising as compared to clinical examination by experienced radiologists, which has an accuracy
rate of approximately 60-70%. To sum up, technological advances in the field of infrared
thermography over the last 20 years warrant a re-evaluation of the use of high-resolution digital
thermographic camera systems in the diagnosis and management of breast cancer. They sum up with
“For breast cancer care, it has become possible to use thermography as a powerful adjunct and
biomarker tool, together with mammography for diagnosis purposes.”

Gołab-Lipinska MV, Jakubowska T, Wysocki M, Kałuzna K, Peszynski-Drews C. 2004(4) agree and
say a change in the thermal pattern is often the earliest sign of a cancer. This information was the
subject of research by Gautherie and Gros (5) who concluded that “an abnormal thermogram is the
single most important marker of high risk for future development of breast cancer with a 94%
predictive marker”.

From New York, Arora N, Martins D, Ruggerio D, Tousimis E, Swistel AJ, Osborne MP, Simmons
RM. 2008 (5), plus from Los Angeles Parisky YR, Sardi A, Hamm R, Hughes K, Esserman L, Rust S,
Callahan K. 2003 (6) state “All reach the conclusion that Infrared Imaging offers a safe non-invasive
procedure that would be valuable as an adjunct to mammography in determining whether a lesion is
benign or malignant.”

Professor Gordon Wishart (7) supports the use of Digital Thermographic imaging especially in
younger women. “It has previously been suggested that Digital Infrared Breast Scan is as sensitive in
younger women as it is in older women. In fact, the results from this study show even better
performance in women under 50, especially when combined with mammography, and I strongly
support the use of this technology for younger women where delays in diagnosis are more common. ”

His research found that the combined use of thermography and mammograms raised the detection rate
to 89% as opposed to the rate for mammograms alone of 78%. Breast Health UK has included the use
of thermograms since 2008.

Long term studies suggest that concerns about false positives are made by those who do not
understand the early significance of inflammatory breast disease.

Research by Buchanan et al 1983 illustrates their findings in regards to this (8). They suggest that
early inflammatory change may be detected from a cell growth of 256 cells. Guido and Schnitt, 1996,
observed that angiogenesis is an early event in the development of breast cancer and may precede any
structural change (8). Vascular changes from angiogenesis are often the first indication of changes in
the breast as a mammogram does not suggest cancer until a high level of cell division has taken place.
More research in this area could lead to an early intervention plan for women displaying this risk.

Thermography is the best way to view inflammatory breast cancer, which does not produce a tumour:

(image will be included in paper submission)

The introduction of a three-dimensional breast model enables thermologists to provide more enhanced
results. Our thermologists have been using 3D techniques for interpretation. Further information on
this is supplied by Lin QY, Yang HQ, Xie SS, Wang YH, Ye Z, Chen SQ. 2009 (9) “It was shown
that the surface thermal characteristics of a small tumour even in a deep region could be found easily
by this method. Furthermore it was also found that the surface thermal characteristics of tumour
obscured due to environmental cooling effect can be clearly displayed. The results are very useful for
analysing breast thermograms.”

Clinical Experience:

(NHMRC has removed content for privacy reasons)  attended our clinic (NHMRC has removed content for privacy reasons) for initial screening because of a
family history of breast cancer. (NHMRC has removed content for privacy reasons) showed abnormal thermal results see
Fig 1 below:

(image will be included in paper submission)

Figure 1 note the changes in the right breast and lymph areas

Thermography was then followed with a mammogram and ultimately ultrasound guided biopsy. The
mammogram had shown no adverse findings and the ultrasound showed enough changes to warrant
biopsy. Subsequent surgery found an infiltrating tumour of at least 40mm Grade 3.

(NHMRC has removed content for privacy reasons) had been screened by us some years ago. She too came from a family with a high
incidence of breast cancer. She had missed a number of years of follow up as she had moved to a
rural area. In the interval she bore two sons who were both breast fed. Her thermogram now showed
high inflammatory changes well into the suspicious temperate range. It was her reporting
thermologist who recommended the full clinical workup, see Fig 2:

(image will be included in paper submission)

Figure 2 high inflammatory changes right breast

As before with (NHMRC has removed content for privacy reasons), the mammogram was clear and the ultrasound biopsy positive. A grade 3,
score 8 tumour was removed at surgery size 60mm. Lymph nodes clear. Because of the clear
mammogram the surgeon had ordered an MRI before proceeding.

The point to note is that both women were asymptomatic and screened at their own request. Both
have since received extensive surgical and oncology follow up. Because of their ages, they would not
have received any type of screening otherwise. They are both extremely grateful that thermography
allowed them to receive the urgent treatment that potentially saved their lives. Both women are well
several years on. Speaking to (NHMRC has removed content for privacy reasons) recently, she informed me that she is the only woman from her
post surgery/ chemotherapy email group who has not developed secondary cancer.

Through various discussions with our local radiologists and (NHMRC has removed content for privacy reasons) surgeon regarding the
problems with the mammograms in these cases, I have been advised that if it is geographically and
financially possible, MRI and possible ultrasound guided biopsy are the better follow up option in the
younger age group. We now follow that advice.

For many years now we have been referring a large number of asymptomatic women on for more
investigation after an abnormal thermogram result, with the majority receiving appropriate medical
treatment. The question arises -what would have happened to these women had they waited until
symptomatic. Indeed some have clear findings on a referral, but my view is that it is always best to
have an anatomical opinion in any suspect situation. Research shows that mammograms also have a
high incidence of false positives.

Thermography is also useful as a monitoring tool for women who have inoperable breast cancer and
undergoing life-extending treatment in various forms. It allows the physician to monitor
inflammatory spread or bilateral breast involvement in a simple and comfortable manner for the

Thermography is a useful adjunctive tool to anatomical screening. It is non-invasive and easily
available to women in all age groups. With increasing research such as that of Gotzche and Neilson
as well as Rafter and Chorozoglou (10) questioning the long term value of screening mammograms,
more research is needed in this whole field.

Phillipe Autier (11) examined the disappointing long term outcome of mammogram screening
programs in six European countries. He concluded “We were surprised and quite sad to find that
breast screening doesn’t work. We were expecting to find the reverse”.
With women themselves doing more research and gaining information on the risks of screening
procedures there is the unequivocal need to provide options and staff who can guide them through the
results to other interventions as appropriate. Digital Thermal Imaging has a relevant role to play in
examining Breast Health.

1. Ng EY, Ung LN, Ng FC, Sim LS. Statistical analysis of healthy and malignant breast thermography. J
Med Eng Technol. 2001
2. Kennedy DA, Lee T, Seely D. A comparative review of thermography as a breast cancer screening
technique. Integr Cancer Ther. 2009 Mar
3. Ng EY, Kee EC. Advanced integrated technique in breast cancer thermography. J Med Eng Technol.
2008 Mar-Apr
4. Gołab-Lipinska MV, Jakubowska T, Wysocki M, Kałuzna K, Peszynski-Drews C. Thermography in the
early detection of breast cancer--our own experience. Wiad Lek. 2004
5. Gautherie M and Gros C. Breast Thermography and cancer risk prediction. Cancer 1980
6. Arora N, Martins D, Ruggerio D, Tousimis E, Swistel AJ, Osborne MP, Simmons RM. Effectiveness of a
noninvasive digital infrared thermal imaging system in the detection of breast cancer. Am J Surg. 2008
Pauline Rose Page 6
7. Parisky YR, Sardi A, Hamm R, Hughes K, Esserman L, Rust S, Callahan K. Efficacy of computerized
infrared imaging analysis to evaluate mammographically suspicious lesions. AJR Am J Roentgenol. 2003
8. Wishart GC, Campisi M, Boswell M, Chapman D, Shackleton V, Iddles S Hallet A Britton P. The
accuracy of digital infrared imaging for breast cancer detection in women undergoing breast biopsy. Eur J
Surg Oncol 2010
9. Buchanan JB et al. Tumor growth, doubling times, and inability of the radiologist to diagnose certain
cancers. Radiol Clin N Am. 1983
10. Guidi A and Schnitt SJ. Angiogenesis in pre-invasive lesions of the breast. The breast J 1996.
11. Lin QY, Yang HQ, Xie SS, Wang YH, Ye Z, Chen SQ. Detecting early breast tumour by finite element
thermal analysis. J Med Eng Technol 2009
12. Gotzsche PC, Neilson M Screening for breast cancer with Mammography Cochrane database Syst Rev
13. Raftery J, Chorozoglou M. Possible net harms of breast cancer screening: updated modelling of Forrest
report. BMJ 2011 Dec
14. Autier P et al. Breast cancer mortality in neighbouring European countries with different levels of
screening but similar access to treatment trend analysis of WHO mortality database. BMJ 2011

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Page reviewed: 3 July, 2013